confused and down med student in need of advice

[caseymd]

Hey all, I needed some input.

I just started fourth year but I'm still very undecided on the field I want to pursue and I'm also really down.

Most of third year was miserable for me and found myself regretting going into medicine. And I don't think it's the field. I think for me I never felt confident in anything that I did, I always felt like I was in someone's way or was way too afraid of doing something wrong or hurting a patient.

I've narrowed it down to anesthesia and family medicine. I know they are extremely different, For anesthesia it really excites, I basically love everything about it. For family I felt semi-competent during rotations enjoyed talking to patients and worked well in the outpatient setting. In my heart I want anesthesia but I feel family might be more manageable for me.

So I'm doing a month of anesthesia now and have a month of family to follow.

But I have to say I have no clue what its going to take for me to step up. I really like anesthesia but I'm so afraid to do anything and when I do, I get nervous. I'm so afraid to touch anything without being told to do so. I was also going to ask my anesthesia preceptor for a LOR but haven't done anything to impress him that there is no way I feel comfortable anymore in asking for one.

For family/intern year I'm terrified of putting in wrong orders, missing something important, not being able to manage a patient and basically looking like an idiot in front all my colleagues

I'm just really down I see how stupid my mistakes are I can't tell which is my problem am I incompetent, not confident or not aggressive enough?

I have way above average grades and am at the top of my class but I'm really starting to think I'm just book smart am going to make a horrible doctor and I should redirect my efforts to finding a desk job before I kill someone.

Any thoughts??? advice???

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[mercaptovizadeh]

Hey all, I needed some input.

I just started fourth year but I'm still very undecided on the field I want to pursue and I'm also really down.

Most of third year was miserable for me and found myself regretting going into medicine. And I don't think it's the field. I think for me I never felt confident in anything that I did, I always felt like I was in someone's way or was way too afraid of doing something wrong or hurting a patient.

I've narrowed it down to anesthesia and family medicine. I know they are extremely different, For anesthesia it really excites, I basically love everything about it. For family I felt semi-competent during rotations enjoyed talking to patients and worked well in the outpatient setting. In my heart I want anesthesia but I feel family might be more manageable for me.

So I'm doing a month of anesthesia now and have a month of family to follow.

But I have to say I have no clue what its going to take for me to step up. I really like anesthesia but I'm so afraid to do anything and when I do, I get nervous. I'm so afraid to touch anything without being told to do so. I was also going to ask my anesthesia preceptor for a LOR but haven't done anything to impress him that there is no way I feel comfortable anymore in asking for one.

For family/intern year I'm terrified of putting in wrong orders, missing something important, not being able to manage a patient and basically looking like an idiot in front all my colleagues

I'm just really down I see how stupid my mistakes are I can't tell which is my problem am I incompetent, not confident or not aggressive enough?

I have way above average grades and am at the top of my class but I'm really starting to think I'm just book smart am going to make a horrible doctor and I should redirect my efforts to finding a desk job before I kill someone.

Any thoughts??? advice???

I think lots of people feel as you do, that they fret over making mistakes and feel like they know nothing. I certainly feel that way. And yet we have "mastered" the exam material. Basically, the first 2 years are just a foundation for understanding the mechanics of your specialty, for dealing with and rationalizing the new and unfamiliar. But they don't teach you much of what actually undergirds any particular specialty, e.g. what sort of anticoagulation to give someone and when, what antibiotic for what bug/empirically/etc., what specifications go into ordering imaging (contrast po or iv, bowel prep for scoping, etc.), not to mention the various techniques of surgery. The point is you learn that by doing. So even if you don't feel the most secure now, during intern year you'll have to pick up the relevant resource (Harrison's, Up-to-date, or something more advanced like a meta-analysis you found on PubMed), put in the orders yourself, and see how things go.

 

[evilbooyaa]

Even during M3, things I had never learned how to do (like which ABx regimen is used at the hospital I was at for the various types of PNA, as well as what to try in a kid with a persistent dry cough in clinic) I was uncomfortable with.

As you experience things and get some routine things, like orders, preps, etc. (which you will when you go into residency) then you will be able to reason your way through the harder things.

I would pick whichever specialty you enjoy more. I think based on the specialties you have decided on, the main question(s) you need to ask yourself are:
1) Do I want to take care of this patient long-term?
2) Do I want to be only in the hospital vs lots of clinic time?
3) Do I want to see kids/OB patients?

 

[Top Gun]

If you're at the top of your class as of right now, I really doubt you're incompetent. Remember that evals count for a significant portion of your clinical grades. If you're getting top grades, you must have done something right in your evals. Also, most third years feel like they're in the way, or like they don't know what they're doing. The third and fourth years of med school teach you what really amounts to a drop in the ocean of clinical medicine. Most of the stuff you need to know you'll pick up during residency, and even afterwards. You need to consider the following: how much patient interaction do you want,do you prefer to follow patients long-term, and how much do you like the procedural aspects of medicine? Those questions should help you in deciding between FM and anesthesia.

 

[caseymd]

Thanks for the replies and reassurance.

I hope I can figure this out soon, I really don't know the answers to those questions yet. Don't know what it's gonna take and I guess I'm waiting for some kind epiphany to motivate me.

In case I can't decide does anyone think is it smart to apply to both?

 

[Top Gun]

Thanks for the replies and reassurance.

I hope I can figure this out soon, I really don't know the answers to those questions yet. Don't know what it's gonna take and I guess I'm waiting for some kind epiphany to motivate me.

In case I can't decide does anyone think is it smart to apply to both?

Its not a bad idea. Anesthesia is moderately competitive, so if you don't get it, you can fall back on family medicine.

 

[mvenus929]

I'm just really down I see how stupid my mistakes are I can't tell which is my problem am I incompetent, not confident or not aggressive enough?

It doesn't sound like you're incompetent. You're just nervous, which is a good thing. You don't want to hurt patients. You shouldn't know everything at this point in your training; that's what residency is for.

It does sound like you could use some confidence, though. It's okay to make mistakes; that's the only way we can learn how not do to something. Get in there to intubate patients, put in lines. You're going to have someone watching you like a hawk anyway, so just take your time and try to remember all the motions.

Aggressiveness is something that I struggle with constantly. This is why I'm not going to be a surgeon. But it will come with a little more confidence.

 

[Cali2]

I wouldn't recommend applying to both fields - they are *so* different that it should be possible to decide between the two after your 4th year clerkships, or even in a pinch based on 3rd year experiences.

Applying to both either just puts off a decision you will have to make anyway or leaves the decision to 'fate' in the match, which is a terrible way to choose your future career. Plus applying to both is an enormous amount of work and expense (think about interview travel) and could make you look like you are not committed to either specialty (and therefore look bad) when it gets out.

Do some soul searching, talk to mentors, and try to schedule rotations in both fields as early as possible, in which you really commit to engaging in the field and being proactive. Then make a decision - perhaps you would be happy in both and there is no wrong choice.